ACOs will likely begin in 2012, and emphasis on quality, satisfaction will accelerate
We don’t claim to be Paul Revere, and we’re not riding white horses. But we do want to shout loud and clear, “Health care changes are coming.”
If the trends currently in motion continue, you will see the beginning of <span class=GramE>accountable</span> care organizations (ACOs) in 2012, with increasing numbers of them year by year, unless there is a repeal of the shared savings portion of the Affordable Care Act or the final rule restricts the potential savings that can be obtained by any ACO.
In addition, if the Republican Medicare voucher plan passes, then everything shifts, in essence, to private insurance. If so, the contractual pressures that we currently see will be enhanced. We will be dealing with a consolidated and very powerful insurance industry.
Regardless of which road we go down, expect the following:
An ever-increasing number of patients will magnify the shortage of urologists that already exists.
There will be increasing scrutiny of your practice based on quality and cost-efficient measures. By the way, don’t forget “patient satisfaction.”
Patients will be required to pay a higher percentage of your fees, resulting in a reluctance to see the doctor until their medical problem worsens. This issue is currently causing a dip in patient visits in many practices.
The real question is: What should you do now to prepare your practice for the coming changes?
We cannot answer that question specifically without a thorough analysis of your practice. Every practice is different, and the circumstances in every geographic area are different. We can only provide you with some ideas you should think about in making your decision on future action.
The first set of recommendations will apply to most practices regardless of size and location:
Design your practice growth through a well-developed business plan and vision. Carefully analyze your strengths, weaknesses, opportunities, and threats from both local and national market pressures.
Develop a data collection and torture method that will allow you to prove the quality and cost efficiency of your practice.<o:p></o:p></span></li>
Obtain the data you need to compare your practice to other urology practices.
Prepare for public knowledge of all aspects of your practice. Transparency is coming. The public will know the volume of surgeries you perform, complication rates, fees, and the payments you accept for services.
Prepare to see more patients. Organize your practice to delegate all functions you do not have to perform so that “you do what you do best and delegate the rest.” Consider the use of non-physician providers; however, if you don’t have any, you can still delegate a significant amount of the work.
Become more efficient and effective in collecting patient co-pays and co-insurance at the time of service or prior to surgery for elective procedures.
What you should know about ACOs –
Hopefully, you are familiar with ACOs. The short explanation is that the ACO is an organization of health care providers that is capable of providing primary care for 5,000 or more Medicare patients.
Many organizations and groups are forming or are thinking of forming ACOs. Examples include well-organized multispecialty groups, hospitals with employed physician groups, independent practicing primary care groups with specialty physicians, specialty organized group practices joint venturing with other specialty groups, and many others. However, the Centers for Medicare & Medicaid Services’ proposed regulations for ACOs have some predicting a lower number of entities participating in the program. The proposed rules were released in April, and there is a 60-day comment period that may result in changes. All are anxiously awaiting the final rule.
The incentive for forming an ACO is the possibility of contracting with Medicare for shared savings. If the ACO can deliver care for a qualifying percentage less than it’s projected that Medicare would otherwise spend, the ACO will be awarded a bonus.
As mentioned, these will be different in each area, and in some geographic areas there could be more than one potential ACO.>
Strategically, you may have to align yourself with strange bedfellows, and if you pick the wrong group, you may be left out of the Medicare contracts. We would suggest, however, that you not rush to join an ACO out of fear of being left out. Don’t forget supply and demand. Each ACO has to contract with enough urologists to take care of all urologic problems, and there is a shortage of urologists.
Some are recommending that you don’t join an ACO, but plan to contract to provide services for one or more plans. Others are cautioning against joining a hospital-based ACO because it will never achieve the cost savings that an ACO managed by physicians, contracting with hospitals, could achieve. Also, some are leery of joining an ACO that is primary care-based. Obviously, these physicians are concerned about the gatekeeper systems of the past.
We feel there is a significant opportunity for groups of urologists to join with other large groups of specialists to form an ACO based on providing quality care that is cost-efficient. We think the system contains enough waste that would allow the group to bend the cost curve and receive bonuses that could increase income. However, you will be required to implement electronic medical records and analyze and act on your data to achieve savings and the payments associated with those savings. It will not be easy, but it is achievable.
Evaluation of patient satisfaction key –
There are several things you can do to prepare for an eventual partnership or contractual relationship with an ACO. First, establish an honest and friendly relationship with the patient. This will require you to provide good customer service and obtain feedback in the form of surveys. Patient satisfaction surveys are already being considered for use by many private payers and the current ACO requirements released by CMS. This will also require that each practice become efficient in discussing costs to the patient and collecting the amounts owed. Patient responsibility is already increasing in the down economy; as a result, we see increasing patient balances and old accounts receivable in practice after practice.
Second, you will need to know what your costs are and whether or not a contract supports your practice goals. Third, you will need expertise in evaluating and negotiating contracts. Contracting will take many forms in the changes that are occurring, so your contracting skills and supporting data will be essential for each practice. Spend time understanding the way you practice and what the associated costs to the system are.
You will also need to be able to market your practice to both the patient and the payer. This will require the ability to accurately report your practice philosophies and the costs associated with your treatment protocols for both marketing and contracting. EMRs will likely become required for these opportunities as well.
Practice plans and implementation of those plans can prepare you for the many potential directions the system may take and help you survive the present.
